Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association | 2021
Ileal Pouch Anal Anastomosis for the Management of Ulcerative Colitis is Associated with Significant Disability.
Abstract
BACKGROUND\nDisability in patients with medically refractory ulcerative colitis (UC) after total proctocolectomy (TPC) with ileal pouch anal anastomosis (IPAA) is not well understood. The aim of this study was to compare disability in patients with IPAA vs medically managed UC, and identify predictors of disability.\n\n\nMETHODS\nThis was a multi-center cross-sectional study performed at five academic institutions in New York City. Patients with medically or surgically treated UC were recruited. Clinical and socioeconomic data were collected and the inflammatory bowel disease disability index (IBD-DI) was administered to eligible patients. Predictors of moderate-severe disability (IBD-DI≥35) were assessed in univariable and multivariable models.\n\n\nRESULTS\nA total of 94 patients with IPAA and 128 patients with medically managed UC completed the IBD-DI. Among patients with IPAA and UC, 35 (37.2%) and 30 (23.4%) had moderate-severe disability, respectively. Patients with IPAA had significantly greater IBD-DI scores compared to patients with medically managed UC (29.8 vs 17.9, p<0.001). When stratified by disease activity, patients with active IPAA disease had significantly greater median IBD-DI scores compared to patients with active UC (44.2 vs 30.4, p=0.01), and patients with inactive IPAA disease had significantly greater median IBD-DI scores compared to patients with inactive UC (23.1 vs 12.5, p<0.001). Moderate-severe disability in patients with IPAA was associated with female sex, active disease, and public insurance.\n\n\nCONCLUSION\nPatients with IPAA have higher disability scores than patients with UC, even after adjustment for disease activity. Female sex and public insurance are predictive of significant disability in patients with IPAA.